Provider Demographics
NPI:1689142010
Name:STEELMAN, KARLIE MARIE
Entity Type:Individual
Prefix:
First Name:KARLIE
Middle Name:MARIE
Last Name:STEELMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARLIE
Other - Middle Name:MARIE
Other - Last Name:ENNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14399 N GAYTON RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5974
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 WEEPING WILLOW DR APT F
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-3966
Practice Address - Country:US
Practice Address - Phone:804-212-6614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-03
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA2305215463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program